Provider Demographics
NPI:1386857902
Name:FARREN, GARY J (DMD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:FARREN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4213
Mailing Address - Country:US
Mailing Address - Phone:207-866-5591
Mailing Address - Fax:207-866-2445
Practice Address - Street 1:379 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:ORONO
Practice Address - State:ME
Practice Address - Zip Code:04473-4213
Practice Address - Country:US
Practice Address - Phone:207-866-5591
Practice Address - Fax:207-866-2445
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME26961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice